augmentation  implants  lift  reduction  reconstruction  rejuvenation  décolleté enhancement 

Arrival 
When you arrive at your surgeon's office, you may be instructed to change into a surgical gown with the opening at the front.  You may have already been told you could take an oral sedative such as diazepam or lorazepam to ease pre-surgical anxiety.  Your surgeon may also measure the position of your areolae in conjunction with your sternal notch, insertion points and dotted lined indicating the intended path of the trocar and threads.  These pre-surgical markings are usually drawn with a Sharpie-type pen or similar single use, pre-surgical marker while you are in an upright position.

Anesthesia
Usually the APTOS breast lift requires no true sedation since it is a short, in-office procedure, however you will probably be given a diazepam or lorazepam if you haven't taken one already.  An oral sedative will make you feel relaxed and some patients may even fall asleep during the procedure.  If this is the case you must arrange for a ride home after the procedure.  You will, however, have local anesthetic injections and should feel no discomfort during the procedure. 

Pre-surgical Scrubbing & Preparation 
Your surgeon, or an attending nurse, will begin to scrub the breasts, upper chest, abdomen and sides of the ribcage with either Betadine (povidone-iodine, 7.5%), pHisoHex (hexachlorophene, 3% ) or Hibiclens (chlorhexidine gluconate, 4%) or similar-type anti-microbial surgical scrub.  However for this procedure, some doctors use only a 70% isopropyl alcohol prep pad swabbed at the insertion points where the trocar is inserted however, Betadine is most commonly used.  Please alert your doctor to any known sensitivity to Betadine.  Using pre-surgical, anti-microbial scrubs will lessen your chances of a bacterial infections from naturally occurring bacteria such as Staphylococcus aureus (S. aureus) which lives on our skin.

The Procedure
After you are scrubbed, swabbed and draped, and you are comfortable and ready to proceed, your surgeon begins the first trocar insertion entering at the predetermined points.  The trocar looks like a hollow stainless tube with a needle-sharp end.  Since this procedure is new, techniques, surgical tools and subsequent results will vary.  

Normally, the trocar is inserted into the subcutaneous fat layer below the skin by the puncture made with the trocar.  With the APTOS breast lift, true incisions are usually not made as the trocar is very sharp and allows for a clean puncture to be made by slightly rotating the trocar during insertion to avoid excising tissue.  The trocar is commonly tunneled along the predetermined plane, which is marked with dotted lines, and the exit point is made with the trocar at the end of this plane. Depending upon the skill of the surgeon, this step may take only a few seconds for each thread.

The APTOS or barbed/cogged threads are made from blue monofilament material called polypropylene and have cogs or barbs which are designed to hook into the subcutaneous tissue.  The use of these monofilament threads was originally pioneered by Marlen A. Salamanidze, M.D. of the Clinic of Plastic and Aesthetic Surgery in Moscow, Russia in 1999 for moderate facial rejuvenation.  Usually, the APTOS threads are inserted into the end of the trocar and pulled through the trocar out of the opposite exit point.  However, some surgeons may not choose to make an exit point for the APTOS breast lift.  

Some threads threads, like those made by K.M.I. (Kolster Methods, Inc), have shorter barbs, or cogs, than the Russian APTOS threads or Silk Lift threads made by Prollenium in Ontario, Canada.  Regardless, after the thread is in place the trocar is removed and the thread held in place.  The thread is then tugged gently backwards and up and the cogs open and catch into the subcutaneous tissue.  This is carried out with all of the threads that will be used, usually from 8 to 18.  The threads are then trimmed to fit and the ends slide out of sight, back into the tissue via the puncture(s).  After each thread is inserted, the breasts are wrapped in compression garments to keep them stable during the healing stage where the collagen will form around the suture material and keep it in place.  This usually occurs within 3 months, however most patients are impatient, choosing to not wear a good supportive bra for the duration of the healing process.

Some doctors have threaded the suture material into the breast tissue itself to help support the tissue, however, the breasts are often too heavy to be supported by the suture material and this effort often fails.  Again, this procedure is very new, has no long-term safety data and is only effective for patients with small, slightly sagging breasts.

After your procedure is over, you will be assisted in standing and monitored for any post-procedure hemorrhaging, or negative reactions to the medications, before being allowed to go home.

You may also feel nauseated.  You may feel cold or hot depending upon your own body.  If you feel either, do let the recovery nurse know so they can either get you another blanket or remove the heated blanket you may have covering you.  if you feel any pain, do let the recovery team know so that you may be given pain medication, however, you usually will not feel pain because of the local anesthetics.  If you are nauseated you may have to be given pain medication intravenously, but your anesthesiologist may have you wait until you are more aware and capable of speaking clearly.  You will nod off and on during this time and your oximeter may sound if you are not breathing deeply enough, thereby not receiving enough oxygen.  

When you are released is usually determined by your oxygen saturation levels and level of awareness.  When your anesthesiologist and surgeon have determined if you are well enough to leave, you will be released to your caretaker and driven home.  You absolutely can not drive yourself home after a surgical procedure.   You will need a caretaker to assist you by waking you for your meds, to fix you something to eat, possibly assist you in walking to the bathroom if you are dizzy from your medications, retrieving items for you such as ice packs, drinking water, etc.

Recovery In The Days Ahead
Please return to the Breast Lift Section for recovery information and what to expect in the following weeks after your Full Anchor Mastopexy surgery.